Impact of International Atomic Energy Agency support to the development of nuclear cardiology in low-and-middle-income countries: Case of Latin America and the Caribbean.

Cardiovascular diseases (CVDs) are the leading cause of death in Latin America and the Caribbean (LAC) region as well as worldwide. Lifestyle, nutritional habits and the upsurge of obesity have contributed to the increase in the prevalence of CVDs in the region. The role of nuclear cardiology in the management of patients with CVDs is well established. Particularly, myocardial perfusion imaging is widely used in LAC countries and has been increasingly integrated into the healthcare systems in the region for the diagnosis of coronary artery disease, risk stratification and to guide patient management. In its role to support countries around the world to address their health needs through the peaceful applications of nuclear techniques, the International Atomic Energy Agency (IAEA) has provided assistance to the LAC region for the establishment and strengthening of the nuclear cardiology practice. To that extent, the IAEA provides support in building capacities of multidisciplinary teams of professionals, the provision of medical equipment and the promotion of communication and exchange of knowledge among the different stakeholders. In addition, the IAEA encourages the participation of nuclear medicine centers in international multi-center research studies. In this paper, we present some of the projects through which the IAEA has supported the LAC region, including regional technical cooperation projects and coordinated research projects related to cardiology within the current multimodality approach to cardiac imaging.

Seasonality of coastal upwelling trends in the Mauritania-Senegalese region under RCP8.5 climate change scenario.

The Mauritania-Senegalese upwelling region (MSUR), the southernmost region of the Canary current upwelling system, is well-known for its coastal productivity and the key role it plays in enriching the oligotrophic open ocean through the offshore transport of the upwelled coastal waters. The great ecological and socio-economic importance makes it necessary to evaluate the impact of climate change on this region. Hence, our main objective is to examine the climate change signal over the MSUR with a high resolution regional climate system model (RCSM) forced by the Earth system model MPI-ESM-LR under RCP8.5 scenario. This RCSM has a regional atmosphere model (REMO) coupled to a global ocean model (MPIOM) with high-resolution in the MSUR, which allows us to evaluate the wind pattern, the ocean stratification, as well as the upwelling source water depth, while maintaining an ocean global domain. Under RCP8.5 scenario, our results show that the upwelling favourable winds of the northern MSUR are year-round intensified, while the southern MSUR presents a strengthening in winter and a weakening in March-April. Along with changes in the wind pattern, we found increased ocean stratification in the spring months. In those months southern MSUR presents a shallowing of the upwelling source water depth associated to changes in both mechanisms. However, in winter the whole MSUR shows a deepening of the upwelling source water depth due to the intensification of the upwelling favourable winds, with the increased ocean stratification playing a secondary role. Our results demonstrate the need to evaluate the future evolution of coastal upwelling systems taking into account their latitudinal and seasonal variability and the joint contribution of both mechanisms.

Immediate post-extraction implants subject to immediate loading: a meta-analytic study.

UNLABELLED: Since Brånemark first started developing its implant system, there has been a continuous and significant evolution in oral implantology through experimental and clinical research, and many of the concepts that were once considered valid have now become the subject of debate. The insertion of the implant immediately after extraction of the tooth to be substituted has now become the implant treatment of choice and is associated with preserving the bone structure and the gingival architecture, as well as with reducing the treatment time, which ultimately benefits the patient. OBJECTIVE: To evaluate the success rate of the immediate post-extraction implants (IPI) subject to immediate loading. STUDY DESIGN: A meta-analytic study was carried out on 659 immediate post-extraction implants obtained from a bibliographic review of 25 articles published within the last 9 years. RESULTS: We obtained a sample of 322 patients who had been treated with a total of 659 implants placed immediately following extraction. The mean age of the patients was 51 years old. A total of 441 implants were inserted in the maxilla, 152 in the mandible and 64 were placed in an unspecified location. The survival rate ranged between 85% and 100%. CONCLUSIONS: Immediate post-extraction implant treatment is an implant alternative with a survival rate similar to that of the conventional technique for implant placement and enables preserving both the bone structure and gingival architecture, as well as providing immediate functional loading, thus improving the quality of the treatment as far as the patient is concerned.

Appropriate use of noninvasive ischemia testing to guide revascularization decision making following acute ST elevation myocardial infarction in Latin American countries: Results from an expert panel meeting of the International Atomic Energy Agency. / Uso adecuado de las pruebas no invasivas de isquemia para guiar la toma de decisión sobre revascularización tras un infarto agudo de miocardio con elevación del segmento ST en países iberoamericanos: Resultados de la reunión de un panel de expertos de la International Atomic Energy Agency.

Across Latin American and Caribbean countries, cardiovascular disease and especially ischemic heart disease is currently the main cause of death both in men and in women. For most Latin American and Caribbean countries, public and community health efforts aim to define care strategies which are both clinically and cost effective and promote primary and secondary prevention, resulting in improved patient outcomes. The optimal approach to deal with acute events such as ST-elevation myocardial infarction (STEMI) is a matter of controversy; however, there is an expanding role for assessing residual ischemic burden in STEMI patients following primary percutaneous coronary intervention. Although randomized clinical trials have established the value of staged fractional flow reserve-guided revascularization, the use of noninvasive functional imaging modalities may play a similar role at a much lower cost. For LAC, available stress imaging techniques could be applied to define residual ischemia in the non-infarct related artery and to target revascularization in a staged procedure after primary percutaneous coronary intervention The use of nuclear cardiac imaging, supported by its relatively wide availability, moderate cost, and robust quantitative capabilities, may serve to guide effective care and to reduce subsequent cardiac events in patients with coronary artery disease. This noninvasive approach may avert potential safety issues with repeat and lengthy invasive procedures, and serve as a baseline for subsequent follow-up stress testing following the index STEMI event. This consensus document was devised from an expert panel meeting of the International Atomic Energy Agency, highlighting available evidence with a focus on the utility of stress myocardial perfusion imaging in post-STEMI patients. The document could serve as guidance to the prudent and appropriate use of nuclear imaging for targeting therapeutic management and avoiding unnecessary invasive procedures within Latin American and Caribbean countries, where resources could be scarce.

Intraoperative radiation therapy in malignant glioma: early clinical results.

Intraoperative radiation therapy (IORT) with high energy electron beams is a treatment modality that has been included in multimodal programs in oncology to improve local tumor control. From August 1991 to December 1993, 17 patients with primary (8) or recurrent (9) high grade malignant gliomas, anaplastic astrocytoma (4), anaplastic oligodendroglioma (6) and glioblastoma multiforme (7), underwent surgical resection and a single dose of 10-20 Gy intraoperative radiation therapy was delivered in tumor bed. Fourteen patients received either pre-operative (8) or post-operative (6) external beam radiation therapy. Primary gliomas: 18-months actuarial survival rate has been 56% (range: 1-21+ months) and the median survival time has not yet been achieved. Four patients developed tumor progression (median time to tumor progression: 9 months). Recurrent gliomas: 18-months actuarial survival rate and median survival time has been 47% and 13 months (range: 6-32+ months) respectively. The median time to tumor progression was 11 months. No IORT related mortality has been observed. IORT is an attractive, tolerable and feasible treatment modality as antitumoral intensification procedure in high grade malignant gliomas.

[The role of PET-FDG in questionable diagnosis of relapse in the presence of radionecrosis of brain tumors]. / Papel de la PET-FDG ante la duda diagnóstica de recidiva frente a radionecrosis en tumores cerebrales.

INTRODUCTION: Although CT and MR are sensitive techniques for the detection of cerebral tumours, both have limitations in distinguishing between tumour relapse (TR) and post-treatment radionecrosis (RN). PATIENTS AND METHODS: In this study we have determined the usefulness of metabolic imaging with PET-FDG in such situations. We assessed 70 patients with CNS tumours (22 low grade astrocytomas, 25 high grade astrocytomas, 3 oligodendrogliomas, 13 metastatic tumours and 7 other tumours. All had been treated with radiotherapy and other treatments such as radiosurgery, chemotherapy or different types of surgery, and presented clinical pictures which made it necessary to decide the differential diagnosis of relapse or radionecrosis. RESULTS: In the PET-FDG study visual and semiquantitative analysis was done by SUV (Standardized Update Value). Confirmation of the findings was obtained in 44 cases (24 TR and 20 RN). MR was doubtful or inconclusive in most cases, whilst with PET correct diagnosis was made in all cases. CONCLUSIONS: Metabolic imaging with PET-FGD is better than anatomostructural imaging techniques for differential diagnosis between tumour relapse and radionecrosis in CNS tumours which have been treated. Prospective studies are necessary for evaluation of SUV as a factor for prognosis of survival.

[Environmental and biological control in a population exposed to isoflurane in the operating room]. / Control ambiental y biológico de una población expuesta a isoflurano en el quirófano.

OBJECTIVE: To measure the level of occupational exposure to isoflurane in the operating room, and to determine the relation between isoflurane concentration in atmospheric and exhaled air. PATIENTS AND METHODS: One hundred seventy-eight samples were obtained from 60 male and female subjects who work in the operating room of our hospital. To monitor workplace exposure we used passive diffusion samplers. Biological monitoring (isoflurane in exhaled air) was accomplished with standard adsorption tubes to collect exhaled air samples. Gases were thermically separated and analyzed by gas chromatography. RESULTS: Atmospheric isoflurane concentrations ranged between 1.14 and 157.23 mg/m3 (geometric mean 16.23 mg/m3). Exhaled isoflurane concentrations ranged from 0.15 to 26.09 mg/m3 (geometric mean 2.85 mg/m3). Atmospheric and exhaled isoflurane concentrations were strongly related (r = 0.82; p < 0.0001). Linearity was determined by the following equation: log of exhaled isoflurane concentration = -0.69 + 0.95 log of atmospheric isoflurane concentration. CONCLUSIONS: The concentrations of isoflurane in atmospheric and exhaled air found in our study exceed the maximum levels for halogenated gases recommended by the National Institute for Occupational Safety and Health, although they do not exceed the levels stipulated by Swiss authorities. In order to adequately assess operating room antipollution measures, atmospheric and biologic monitoring of isoflurane and other inhaled anesthetic gas concentrations is necessary.

Cutaneous hyperpigmentation induced by omeprazole mimicking ashy dermatosis.

BACKGROUND: Omeprazole has been associated with multiple adverse effects including skin reactions but, to date, cutaneous hyperpigmentation has not been described as an adverse effect of this drug. OBSERVATIONS: We describe a case of a 52-year-old Caucasian woman who developed skin hyperpigmentation in the upper trunk, mimicking ashy dermatosis, 2 months after initiating omeprazole treatment. Histopathologic examination of a skin biopsy taken from a pigmented macule showed dermal macrophages containing golden-brown granules, which also displayed a sulphur peak on energy-dispersive X-ray microanalysis. High-performance liquid chromatography (HPLC) and mass spectrometry were also performed on the drug and on a biopsy specimen revealing the same chromatograms as well as the same mass spectra. CONCLUSIONS: According to our results, omeprazole itself may induce cutaneous pigmentation and, to our knowledge, this is the first report of this finding.